Liver cancer is one of the most significant causes of death from cancer in Germany. We have found a steady increase in mortality rates from cancer of the liver and intrahepatic bile ducts over the last 30 years with more pronounced increase among men which has also been found in the incidence estimates. Regional variability has also been largely demonstrated particularly among men. East-west and south-north decreasing gradients in incidence and mortality were observed. Among men, increasing trends in mortality were seen in many regions with highest increase observed in the Southeast and South since 1980.
The reasons for these observed trends are as yet not clear. It is likely that variations in the prevalence of HCV (and probably HBV) and alcohol consumption could have a major influence. However, data on risk factors (especially HBV and HCV) and their time trends are insufficient to draw a clear conclusion. It seems that alcohol is the most possible explanation for the difference between the East and West, however, it is less likely to explain the differences between the South and North and also less likely to explain the rising trends in incidence and mortality rates because the data suggest that trends in alcohol consumption and mortality from alcohol cirrhosis have very slightly changed or declined.
Immigrants from high-prevalence areas for hepatitis viruses form a group of population at increased risk for liver cancer and may also contribute to the rising liver cancer trends observed in Germany. Despite the great achievements made by prevention programs to reduce the incidence of viral hepatitis infections that has been observed over the last few years, however these programs should also reach this group of people to prevent new infections and provide appropriate treatment to those already infected.
Recommendations:
Epidemiological studies such as case-control or prospective cohort studies are highly needed to determine the contribution of viral hepatitis, alcohol and other possible risk factors including NAFLD, obesity and diabetes mellitus, and to evaluate their role in the future trends of liver cancer in Germany.
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Master Thesis | WS 2011/12 A Appendix I
Table 8: number of cancer-related deaths and age-standardized mortality rates for selected cancers in Germany, 2009
(Deaths per 100,000 to European Standard population)
Cancer sites ICD-10 codes Men women
Deaths ASMR Deaths ASMR
Oral cavity and pharynx C00-14 3813 7.4 1169 1.8
Oesophagus C15 3776 6.8 1161 1.6
Stomach C16 5783 10.0 4461 5.4
Colon and rectum C18-21 13572 23.2 12504 14.2
Liver C22 4738 8.1 2493 3.0
Gallbladder and extrahepatic bile ducts C23-24 1190 2 2035 2.1
Pancreas C25 7410 12.9 7749 9.4
Larynx C32 1215 2.2 162 0.3
Lung C33, C34 29158 50.6 13103 19.3
Malignant melanoma of the skin C43 1454 2.6 1203 1.7
Breast C50 131 0.2 17066 24.0
Cervix C53 1581 2.6
Uterus (corpus uteri) C54, C55 2360 2.9
Ovaries C56 5623 7.7
Prostate C61 12217 20.0
Testis C62 170 0.4
Kidney an efferent urinary tract C64-66, C68 4807 8.2 2908 3.5
Bladder* C67 3587 6.0 1766 1.8
Nervous system C70-72 3130 6.0 2609 4.1
Thyroid gland C73 262 0.5 429 0.5
Hodgkin's lymphoma C81 173 0.3 139 0.2
Non-Hodgkin lymphoma C82-85 2999 5.1 2658 3.1
Plasmacytoma/multiple myeloma C90 1809 3.0 1828 2.1
Leukaemia’s C91-95 3799 6.5 3308 4.1
All malignant neoplasms** C00-97 116383 201.4 99155 128.6
*not include malignant neoplasms in situ and neoplasms of uncertain behaviour
**not include non-melanoma skin cancer (C44) ASMR: age-standardized mortality rates
Table 9: age-specific mortality rates (5-years age group) of primary liver cancer patients (ICD-10 C22) by sex, 2009
(Deaths per 100,000)
Age group Men Women Both sexes
0-5 0.0 0.1 0.0
5-10 0.0 0.1 0.0
10-15 0.0 0.0 0.0
15-20 0.1 0.1 0.1
20-25 0.1 0.0 0.0
Im Dokument
Liver and Intrahepatic Bile Ducts Cancer (ICD-10 C22) in Germany
(Seite 57-83)